The Price of Tomorrow’s Plague

The day-to-day grind of saving the world is not glamorous. At the Centers for Disease Control and Prevention (CDC), a sizeable portion of the work involves testing samples from receiving centers, crunching data and finding out if a grocery store’s brussel sprouts or chicken salad has caused the latest salmonella outbreak. Such mundane work in controlling the spread of the disease is taken almost for granted in modern times, allowing organizations like the CDC to fall by the wayside. Once in a while, the CDC works on an exciting, high profile case, such as the rapid containment of the 2013 Ebola outbreak. Whether it is trekking for miles on foot to investigate a suspected case of Ebola in an isolated region Sierra Leone or advising people to toss their chicken salads, the CDC plays a critical role in preserving public health. Oftentimes, an appropriate response from the CDC decides whether an infectious outbreak becomes a contained case or a pandemic.

The CDC’s role in controlling outbreaks are even more important in today’s increasingly mobile and globalized society. The rate of disease propagation is faster than it has ever been. When the Black Death devastated Europe, it spread as a gradual wave, but diseases today can cross continents with ease, jumping from a rural village to any major city in 36 hours (4). Other risk factors influence the rate of disease transmission, include increasing antibiotic resistance, climate change increasing the range of disease transmission (10), the anti-vaccination movement and limited access to healthcare for the impoverished. However, for the leaders of most developed nations, the fear of pandemics is rarely the most pressing issue they face. News of political crises or technological developments tend to dominate the headlines until a disease proves its infectiousness and virulence. While some diseases seem to appear in the media spotlight overnight, they are typically unlikely to reach the frightening heights of pandemics of the not so distant past, as there are protocols in place to rein in its spread. The CDC plays a large role in establishing these protocols, researching potentially deadly diseases, training healthcare professionals and maintaining public health programs (2). However, the CDC is expected to hit a fiscal cliff by September 2019. The exhaustion of a past 2014 emergency grant reduces funding for the infectious disease program by 80 percent. This funding cut to infectious disease prevention is in addition to a planned 20 percent cut of $1.4 billion to the CDC’s budget for the 2019 fiscal year. Thus, drastic downsizing in the form of pulling back employees may be on the horizon since there has been no guarantee for continued funding of infectious disease programs from the current D.C. administration.

The 2013 Ebola outbreak was the worst in recorded history. In response to this outbreak, Congress granted the CDC a five-year emergency funding package in 2014 (11). The purpose of the package was to provide medical support for the affected West African countries and fuel the prevention of the epidemic spreading into international proportions. This funding is set to run out in September of 2019, which forces the CDC to withdraw from 39 of the 49 countries it is currently active in. Many of the countries that will be left behind are hotspots for emerging infectious diseases, such as Haiti, Rwanda, China and the Democratic Republic of Congo (11). Critics of the decision argue that this may not only leave the U.S and the world at-large more vulnerable when the next outbreak emerges, but may also set back scientific and diplomatic relationships with the countries that the CDC is forced to withdraw from. In a letter to Health and Human Services Secretary Alex Azarmore, more than 200 international health entities stated, “Not only will CDC be forced to narrow its countries of operations, but the U.S. also stands to lose vital information about epidemic threats garnered on the ground through trusted relationships, real-time surveillance and research,” (9). The programs at risk are “the front line against terrible organisms… like terrorism, you can’t fight [dangerous pathogens] just within our borders. You’ve got to fight epidemic diseases where they emerge.” said Tom Frieden, the former CDC director who led the agency during the Ebola and Zika outbreaks (6). The CDC also states on its website that, “The U.S. cannot protect its borders and the health of its citizens without addressing diseases elsewhere in the world,” (3). It is very tempting for people to think of infectious disease as a foreign threat only to be dealt with within their country’s borders. Most people in developed countries die of chronic and not infectious diseases, leading them to assume that such diseases are a third world issue, but they are a global issue that must be collaboratively dealt with on a global scale. In addition, the downsizing of the CDC has been hypothesized by other public health experts, such as the Director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health Tom Inglesby, of having the potential to lead other countries to do the same with their own similar health institutions (9).

These budget cuts and the overall downsizing in store for the CDC reflects not only a changing attitude towards disease, but also a shift to an “everyone-for-themselves” mindset. Many Americans feel that public health funding should not be spent on overseas efforts, but rather on American soil. In addition, recent leadership scandals, such as the resignation of CDC Director Brenda Fitzgerald over owning stock in major tobacco and pharmaceutical companies, have shaken the American public’s trust in the organization (8). The CDC’s original purpose was to literally drain the swamp, to prevent outbreaks of malaria and yellow fever, which are all but eliminated in the U.S today. However, the organization has become increasingly mired down by accusations of profiteering. Despite the occurences of costly, high profile outbreaks, like Ebola and Zika, complacency about disease outbreaks is becoming the norm. Paradoxically, the failure of these global diseases, to establish firm footholds in the U.S. has often been used to justify the slashing of the CDC’s budget. Overconfidence in curative measures also turns infectious diseases into a contest of who has the resources to be treated and who does not, rather than an attempt to ensure no one needs treatment in the first place (7). Partially as a result of this mindset, it seems like the severity of outbreaks may increase rather than decrease in the future (10). The CDC downsizing may have been a result of the current administration, but changing societal attitudes about disease and disease prevention mean there is little outcry or attention given to the issue.

With the recent major advances in technology and healthcare, the general public perceives infectious diseases as mere, minor inconveniences compared to chronic illnesses, such as cancer or cardiovascular disease. Yet, prior to World War II, infectious diseases were the leading cause of death across all age groups (1). Despite this year’s strain of influenza proving itself particularly infectious, a respiratory infection no longer strikes the same fear in the public. This almost passive attitude towards the past wave of influenza reveals that there is currently an overconfidence in the strides made against infectious disease. The public’s distorted perception on the potential severity of infectious diseases has influenced the acceptance of the CDC’s overseas prevention programs being cut. However, in contrast to popular belief, scientists suggest that part of the reason that recent outbreaks have not reached global levels is through simply luck (7)(8). Although, most of the outbreaks have not been a combination of both high transmission and mortality rates in recent years, cutting the CDC’s funding could mean undercutting disease prevention efforts and playing genetic Russian roulette at times when the world is most vulnerable.